5900-06 FF, Fee Filing Form

OMB No. 2060-0336, Approval Expires 04/30/2012

Federal Operating Permit Program (40 CFR Part 71)
FEE FILING FORM (FF)
Complete this form each time you prepare form FEE and send this form to the appropriate lockbox bank
address, along with full payment. This form required at time of initial fee payment, and thereafter, when
paying annual fees.
Source or Facility Name__________________________________________________________
Source Location _______________________________________________________________
EPA Region where Source Located _____________________

Mailing Address:
Street/P.O. Box ______________________________ City_____________________________
State ______

ZIP __________ - ______

Contact Person:_____________________________ Title______________________________
Telephone ( ____ ) _____ - __________

Total Fee Payment Remitted:

EPA Form 5900-06

Ext. __________

$ __________________._____

INSTRUCTIONS FOR FF (FEE FILING FORM)
Source Location: The actual location of the source: Street address (if any), City (if any), County, and
State.
Mailing Address: This is the address we should use to send any correspondence concerning fee payment.
This address may be different than the source location, such as a corporate office.
EPA Region: The EPA region in which the source is located (e.g., EPA Region 8)
Contact: This should be the person that can best answer questions concerning fee payment.
Payment of part 71 fees, interest and penalties may be made by check or electronic means as follows.
CHECK PAYMENT:
 Fee payment shall be in U.S. currency drawn on a U.S. bank and made out to the order of the
US Environmental Protection Agency.
 Please send this form (FF) with check payment to one of the addresses below:
 Also send a photocopy of the check to the EPA regional office (or delegate agency) with form
FEE.
Address for Regular Mail through U.S. Postal Service (USPS):
U.S. Environmental Protection Agency
FOIA and Miscellaneous Payments
Cincinnati Finance Center
PO Box 979078
St. Louis, MO 63197-9000
Address for Express Delivery (or When a Physical Address is Required):
U.S. Bank
Government Lockbox 979078
US EPA FOIA & Misc. Payments
1005 Convention Plaza
Mail Station SL-MO-C2-GL
St. Louis, MO 63101
Contact: Natalie Pearson ( U.S. Bank)
314-418-4087
FOR ELECTRONIC PAYMENTS: See link below for more information on making electronic payments.
FOR MORE INFORMATION: The following links provides detailed information on how to make payments
to EPA for part 71 fees, penalties, and interest, including contact information for EPA’s Accounts
Receivable Branch in Cincinnati (Note that more specific information concerning part 71 fees is found on
the second link under “FOIA and Miscellaneous Payments.”
http://www.epa.gov/ocfo/finservices/make_a_payment.htm
http://www.epa.gov/ocfo/finservices/payment_instructions.htm

EPA Form 5900-06